by Dr Kirsty Benton
There has been a lot of press regarding Resuscitation Forms during Covid-19. I hope this post will help to explain what DNACPR forms mean to us in the healthcare profession and with that, allay some of the concerns that have been created by the media coverage.
So what is a DNACPR? It is a legal document signed by a doctor to ensure we Do Not Attempt Cardio-Pulmonary Resuscitation in specific patients. They are often associated with a TEP form – Treatment Escalation Plan – which explains many levels of medical interventions we can give before the heart stops. This ranges from minimally invasive procedures up to the more invasive and often unpleasant interventions that are offered in Intensive Care.
There are many misconceptions about DNACPR forms, which is understandable. Care around death is not something people want to think about, let alone discuss the intricacies of. To be clear, we are NOT talking about Palliative Care, which is the stopping of active treatment and shift to focus on comfort only at the end of life. DNACPRs are different. They are not just for people who are nearing the end of life and healthcare professionals believe that DNACPR discussions should happen whilst people are fit and healthy and before getting to the stage where they are so unwell that these discussions are more challenging and we have to make decisions without knowing what was important to our patient.
In my opinion DNACPRs enable 3 key things: They give people the opportunity to think about and document what is important to them if they become critically unwell and their heart was to stop. We can then translate that into clinical practice in the things that we would and wouldn’t do for them. Often our elderly patients have already decided what is important to them and many of these conversations, although not pleasant to discuss, are straightforward.
It gives us as doctors the chance to explain what CPR actually is and what it involves. DNACPRs are specifically talking about when the heart stops beating and there are only a few things that we can do that might help the heart restart. These interventions come with their own potential problems even if successful. We also can explain the likely success or failure from CPR. This depends on a lot of factors, including other illnesses they have, frailty and age. Even if CPR does restart the heart it is often associated with a period of reduced oxygen levels in the body and can cause damage to the brain. Once again this gives someone the chance to tell us whether they would want CPR knowing the chances of survival and knowing that their life and function afterwards may be different if it is successful.
There are situations where decisions about CPR can be more challenging. If someone does not have the mental capacity to make a decision about their health, for example, if they are confused or severely unwell this can be difficult. Their doctors will always do their best to explore what is important to the patient and if they have had previous discussions with their next of kin or GP. Doctors will take all the information they have available to then make a decision in the best interest of the patient and to balance potential benefit against the risk of CPR.
It is really important to clarify that DNACPR forms are not a sign that we are giving up. We will always continue to deliver the best care possible in the best interests of our patients. I appreciate this topic can be really upsetting so please contact me directly on @expeditiondoctorkirsty if you would like to ask me any questions.